Questions and Answers on the Circumcision of Boys
Preliminary remark: Hotly disputed subjects should be treated with a „cool head”. The circumcision of boys is certainly such a hotly disputed subject. Therefore, it is hardly surprising that the public discussion turned stormy. Advocates of circumcision accused its opponents of anti-Semite/anti-Muslim motives. Opponents, on the other hand accused parents willing to circumcise their sons of being unloving and ignorant of their children’s agonies.
We are convinced that such a controversy is counterproductive as it blurs both groups’ true motives and hampers the search for reasonable solutions. Where an issue as complex as the circumcision of boys is concerned, rational arguments should prevail and not mere assumptions. Sadly, most people are quite unfamiliar with the actual consequences of circumcision. If parents knew of these consequences, one wouldn’t have to discuss banning circumcision, as most mothers and fathers would not consider imposing it on their children. In other words: The key problem in current debate lies in the lack of knowledge about the subject and in the intentional disinformation of parents, which we would like to counteract with the following list of key questions and their answers.
8. If circumcision does more harm than good to a child’s well being, why is the procedure still routinely performed in the U.S.? Why do so few circumcised men articulate the negative consequences of circumcision and why do they so often have their own sons circumcised?
Circumcision is, as we will later explain in more detail, a high-risk, painful, sometimes even traumatising procedure, which results in the irreversible amputation of a highly sensitive, functional and useful part of the body. An encroachment of this kind into the right of self-determination and the physical integrity of a child cannot be justified by appealing to parenting rights. It doesn’t matter if the parents’ interest in having their son circumcised is religiously, traditionally, allegedly hygienically or aesthetically motivated. Only in the rare case in which circumcision is medically essential, can it be legitimate.
In this context one should acknowledge that paediatricians have dramatically rethought circumcision in the past years. Phimosis used to quickly lead to circumcision, whereas doctors now wait to see if the „problem” (which is actually a normal physiological condition during the development of a boy’s body that may lead to problems only after puberty) solves itself (which is mostly the case). If not, more gentle remedies are applied (ointments, stretching of the foreskin etc.). Due to the wide-ranging consequences, the partial or complete amputation of the foreskin is only indicated when all the other therapeutic attempts have failed.
This comparison must be rejected in several respects: First, genital cutting is much more painful than ear-piercing. Second, circumcision means irreversibly removing around 50 per cent of the entire penile skin, which, quantitatively, would roughly correspond to an amputation of the earlobes, which surely nobody would expect of their children. Third, the foreskin cannot be qualitatively compared with the earlobes, as the foreskin consists of the most sensitive tissue of the male body. Fourth, in contrast to circumcision, the piercing of earlobes doesn’t impair important biological bodily functions (see question 4). And fifth, ears are usually pierced when the children explicitly request it – apart from that, the procedure is also questionable, although not nearly as problematic as genital cutting.
Muslims who were circumcised as school children often have traumatic memories of the “circumcision celebration”, even though only few of them are courageous enough to speak of it openly. One of the rare exceptions is Ex-Muslim Ali Utlu from Cologne, who described his circumcision as follows: “We struggled and screamed, but four men held us down. It was a completely horrific experience for me and has been burned into my mind forever.”
As school children experience the pain during their circumcision very consciously, more and more Muslim doctors advise that the boys be circumcised as early as possible, which is already standard procedure in Jewish circumcisions. But is circumcision as practised by Jews on eight-day-old infants really less traumatic?
For a long time it was actually believed that infants felt less pain. Some newborns suddenly fall silent and seem to fall asleep during the procedure, which appeared to indicate that they indeed felt nothing. Today we know (though it is not yet general knowledge) that these children are in a state of traumatic shock. Because newborns experience pain much more intensely than older children or adults! The reason: The pain suppressing system that makes the experience of pain bearable through the release of endorphins, doesn’t function until a few months after birth.
The director of the German Children’s Pain Centre (Kinderschmerzzentrum), Boris Zernikow, pointed out in an interview in August 2012 that a specific pain memory may develop through the unmitigated circumcision pain a newborn experiences. Months after the circumcision the children feel more pain when they are vaccinated and release higher doses of the stress hormone cortisol. On the whole, their pain threshold is lower and the danger of chronic pain higher. Tragically, this cannot be prevented by a general anaesthesia, says Zernikow. Instead, the nerve pathways that lead from the penis to the brain need to be directly blocked, which even anaesthetists in good clinics don’t achieve in five to ten per cent of cases.
To begin with, one has to state that the tonsils and the appendix are anything but superfluous, which is why no reasonable doctor would think of removing these organs as a precautionary measure against future inflammations. Removing the tonsils or the appendix without medical indication would rightly be judged as illegitimate physical injury. The same should be applied to the removal of the foreskin without medical indication.
Because the foreskin has important bodily functions: It protects the glans from abrasion, drying, callusing (keratinisation), and contaminants of all kinds. In the beginning, it is stuck to the glans, so that the glans is protected from the boy’s excretions throughout infancy and childhood. Come puberty, it one of the primary sources of male pleasure, as it contains about 20,000 sensitive receptors. These make the foreskin the most sensitive region of the male body, far more sensitive than for example the fingertips or lips.
If the foreskin, which contains about 70 per cent of the penile sensorial tissue, is removed, this inevitably leads to a loss of sensitivity. Men who have been circumcised as adults and who have had sexual experience before the procedure, often complain about massive loss of sexual pleasure. Others however perceive the sensitivity loss as less dramatic. Only a minority finds that their sexual pleasure is enhanced. To what these differing subjective evaluations can be attributed, hasn’t yet been investigated. But it has been proven that, as they age, circumcised men are significantly more prone than others to erectile and orgasmic dysfunctions.
Indeed, parents and doctors believed for a long time that the removal of the foreskin had hygienic advantages. This was due to the fact that the biological function of smegma, which forms under the foreskin, was widely unknown. Smegma is not “dirty sludge”, as many think, but a “natural moisturiser” which the body actively develops and which has proved useful in evolution: for smegma keeps the glans moisturised, prevents injuries, kills germs and serves as lubricant during intercourse. If the foreskin is removed, the smegma cannot be developed, which may lead to keratinisation and blunted sensitivity of the glans.
But what about the health advantages that the advocates of circumcision keep invoking? The answer is surprisingly clear: There is no credible evidence for any health advantages of circumcision! Every study that tried to establish such advantages in the past has meanwhile been falsified. This also applies to the widely cited study by the World Health Organisation, which advised men (not children!) in some African countries (not in Germany) to have themselves circumcised in order to reduce the risk of an HIV-infection. In contrast, more recent surveys have shown that in most countries circumcised men have even a greater risk of HIV-infection than men with an intact foreskin. The reasons for that have not yet been completely clarified. One of the reasons may lie in the fact that circumcised men tend to use condoms less often, because of the loss of sensitivity. (Many report that they feel almost nothing when using a condom during intercourse.) By avoiding the use of condoms not only does their risk of infection increase, it is also more probable that they infect others and therefore contribute to spreading epidemics. (By the way, the risk of HIV-infection also increases directly through circumcision, namely when the procedure takes place under hygienically questionable conditions, as are often encountered in the regions worst affected by HIV.)
Even under ideal medical conditions, every fifth infant suffers from post-operative problems, says the renowned child urologist Maximilian Stehr. These can be so severe that they need further surgery. The main reasons are secondary haemorrhage, infections, boils and the constriction of the urinary meatus. Injuries of the glans are not rare, and even amputations of the penis have occurred in Germany.
In addition to the direct complications of circumcision there are indirect ones, such as the risks that accompany anaesthetics and narcotics. Regrettably, the cases aren’t systematically documented. But some dramatic individual cases are known. Stehr gives the account of a boy who suffered from lack of oxygen after anaesthesia in 2001 and since then has been profoundly disabled. In his book “un-heil. Vorhaut, Phimose & Beschneidung” (“calamity. Foreskin, phimosis and circumcision”), the author Mario Lichtenheldt refers to a second German case in 2006 where a boy died directly after his circumcision. The four-year-old had suffered from complications during the waking stage following the anaesthesia, whereupon the treating doctor infused a far too high and in the end fatal dosage of glucose.
In industrial nations however, the biggest mortal danger for circumcised boys arises from infections (for example with MRSA). A study published in 2010 came to the conclusion that in the US alone 117 infants die every year due to infections following their circumcision. In countries with worse medical care the number of boys who pay with their lives for a circumcision that is not medically indicated is many times higher. Although the worldwide mortality rate of boys following circumcision is hard to estimate, we have to assume that year after year thousands of boys don’t survive the consequences of the procedure.
Of course – and it may be the greatest scandal in the current debate that this comparison has been broadly considered taboo! Although the infibulation, the stitching of the vagina after the removal of the outer clitoris and the labia, is more dramatic than the genital cutting of boys, there are also forms that are evidently “less harmful”, for example the removal of the foreskin of the clitoris or its mere pricking or incision. After all, it is known that the male foreskin contains about double as many nerve endings as the female foreskin and is physiologically far more important.
Therefore, there is no reason for tolerating the cutting of the male foreskin whilst all forms of female genital cutting – including the “milder” varieties – are internationally banned. If legislature protected the physical integrity of girls while sacrificing the physical integrity of boys, that would be a clear violation of the principle of gender equality. It also threatens the argumentation against female genital mutilation. Because all of the arguments against the genital cutting of girls also apply to the genital cutting of boys.
It should also be noted that girls suffer genital cutting only in regions, in which boys are circumcised. Researchers assume that the genital cutting of boys, which is performed about five to six times more frequently, is the older ritual, from which female genital cutting was later derived. Therefore, a ban on the circumcision of boys might indirectly lead to a decline in the genital cutting of girls.
The circumcision of boys (for a while also of girls!) in the United States began around 150 years ago. At that time, circumcision was in no way promoted as a medical-hygienic measure, but rather as a method to impede and punish masturbation. One of the most important initiators of the American Circumcision Movement was the influential American doctor John Harvey Kellogg, best known as inventor of the cornflakes that bear his name. Kellogg, who was not only one of the leading Adventists of his day, but also a rigorous advocate of sexual abstinence, phrased the advantages of circumcision as follows: “A remedy for masturbation which is almost always successful in small boys is circumcision… The operation should be performed by a surgeon without administering anaesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. (…) In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement.”
Scientific studies have shown that Kellogg was definitely right in his supposition that circumcision would impede masturbation. In 1999, a South-Korean survey concluded that circumcision was connected to a qualitative impairment of sexual gratification, especially when masturbating. 48 per cent of the men interviewed said that, following circumcision, sexual gratification through masturbation had decreased, while only 8 per cent said it had increased. In addition, 63 per cent reported having difficulty masturbating after they had been circumcised.
Hardly anyone denies that routine circumcision in America was initially designed to prevent masturbation. It took several decades before medical-hygienic arguments were brought forth in order to justify the procedure. As these arguments were increasingly subject to criticism, the number of circumcisions in the US decreased over time. Whereas in the 1970s more than 90 per cent of the male infants were routinely circumcised, nowadays less than half the boys are victims of the procedure. One can assume that these circumcision rates will further decrease in the coming years.
There are several reasons that need to be taken into account: First, men who were circumcised when they were infants don’t know which bodily functions they have been deprived of by the removal of their foreskin. Furthermore, they are not conscious of the pain they have suffered as infants. The first argument also applies to men who were circumcised later in their childhood. They also don’t know what sexuality feels like with an intact foreskin. At least some of them remember the pain they felt during the procedure. So why would they wish that their children share the same fate?
Here one needs to consider a psycho-social mechanism which the psychologist and specialist for childhood issues, Alice Miller, presented in the 1970s with remarkable clarity: Children tend to exculpate objectively harmful parental behaviour in order to preserve the ideal image of their parents essential for survival. When they themselves become parents they’re at risk of repeating the objectively harmful behaviour while rearing their own children in order to confirm the ideal image of their parents once again.
Furthermore, research in neuroscience has shown that traumatic experiences during childhood leave traces in the brain that can permanently impair the capacity to empathise. That is why traumatic experiences are often passed on from generation to generation.
It is especially difficult to perceive such objectively harmful behaviour when it is demanded by a religious tradition that provides part of one’s identity. After all, it belongs to the basic beliefs of each religion that their gods and prophets – in contrast to the gods and prophets of other religions – never err! This leads to religiously motivated advocates of circumcision having an especially strong aversion to facing the empirical findings of science, where these contradict their own beliefs.
On top of that, rationalising strategies are common among circumcised men. That means: In order to not have to admit to a possible disadvantage of the circumcision, actual or alleged advantages of circumcision are stressed, the disadvantages which are associated with it are blocked out. So circumcised men generally think of themselves as “more pure” while they ignore the biological functions of the allegedly “impure” smegma (see question 5). They are also proud of their sexual endurance while forgetting that not only can they endure longer, but they must endure longer until reaching an orgasm, which can lead to real problems with increasing age (see question 4). Furthermore, while claiming to be able to give their sexual partners greater pleasure, they overlook the fact that, due to their diminished sensitivity, they typically (though this need not apply to every individual) prefer rougher sexual practices, which not every woman favours.
Another significant rationalisation must not be forgotten in this context: Many (men and women) believe that one only becomes a “real man” by suffering the pain that accompanies circumcision. (“An Indian knows no pain!”) This macho myth is undoubtedly one of the causes for generally categorising genitally cut girls as victims, in contrast to boys who suffer the same fate. So here we find one of the reasons for the strikingly different evaluations of female and male genital cutting.
A ban by society on the circumcision of boys where there is no medical reason should necessarily be accompanied by a broad awareness campaign publicizing the consequences of circumcision. We are confident that the vast majority of mothers and fathers who learned of these quite recent research findings, would no longer instigate the circumcision of their children. A ban would therefore not deprive them of their right of decision but rather strengthen them in their newly won insights.
But the ban would be effective for those parents who refuse point blank to acknowledge scientific results or are willing to knowingly violate their children’s well-being. In those cases state authorities have to intervene to ensure the child’s well-being – even against the opposing wishes of their parents. This has been common legal practice in all modern constitutional states for a long time. Happily, this principle has been pursued consistently in the case of female genital cutting for some time, with the government authorities meeting the requirements of the UN-Convention on the Rights of the Child, in which is written that State Parties “shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.” Because of the parallels between female and male genital cutting (see question 7) there are no plausible arguments why boys shouldn’t be protected from traditional practices prejudicial to their health, as are girls.
In the context of the governmental restriction of parental authority, one must stress that the democratic constitutional state may only intervene in cases of emergency, namely when the well-being of the child is directly and significantly at risk. The constitution gives parents great liberty, allowing them to make far-reaching decisions influencing their children’s lives. If, for example, they tell their child that man has nothing whatsoever to do with evolution and the apes and that God created the Earth a few thousand years ago, the government has to tolerate this, despite modern knowledge of evolutionary biology and radio-carbon dating. (In schools, however, spreading such misinformation is not permitted.)
Large though it is, parents’ dominion does have limits: If a father cites the Bible (for example Proverbs 13, 24) as justification for beating his child in order to raise it as the Bible demands, the state has a duty to intervene. Parents’ rights to raise their children as they see fit, do not include the right to employ physical punishment. And what is a slap in the face compared to forced genital cutting? With their verdict, the judges of the Cologne district court who started off the debate on circumcision only stressed something that is self-evident: Since parental authority must serve the well-being of the child, the violation of the child’s physical integrity cannot be tolerated – even if the injury is based on ancient religious traditions. And in any case, why should the age of a tradition mean that it can’t be questioned? On the contrary: The older such traditions are, the more necessary it is to review them, as they are probably not in accordance with human rights, which were only formulated at a much later stage of cultural evolution.
One should also note that the development of specific children’s rights is even younger than the wording of the general human rights: Not until 40 years ago did Germany begin to take children seriously as legal persons. And only since 1979 have they been protected from corporal punishment at school. In the 1990s children were granted a legal entitlement to adequate sustenance and education. Since 2000 they have been entitled to a nonviolent upbringing in the family. If one takes this latter right literally, then medically superfluous genital cuttings, which violate the right of self-determination and of physical integrity, should have become obsolete – for boys as well as girls.
That is a widespread misunderstanding: In fact, a ban on forced genital cutting would even contribute to strengthening the right to the free practice of religion, namely through the overdue consideration of children’s free exercise of religion. Because the parents’ right to the free practice of religion extends only to themselves – and not to an influence over their children, who have the right to develop their own religious beliefs, independent of those of their parents.
Admittedly, children are later able to discard their original religion, even when they have been undergone forced circumcision. Nevertheless, religious circumcision is a life-long label, which may be perceived as a burden – quite apart from all the other disadvantages of the removal of the foreskin. Ex-Muslim Ali Utlu from Cologne expressed it like this: “For me, it was in retrospect a branding by religion. As if somebody stamped a cow and said: You belong to my herd.”
If religious circumcisions were performed at an age when the persons concerned could decide for themselves and gauge the consequences, these feelings of outside control could be avoided. That would be an important step towards greater individual self-determination and religious freedom. But obviously not everybody wants that. In a television broadcast of “Menschen bei Maischberger” in mid-August 2012, the Muslim doctor and specialist for circumcision Sebastian Isik argued the case for performing the circumcision at an early age, as most 16 year-olds would probably not consent to the procedure anymore. This unintentionally revealing statement emphasizes how the established practice of circumcision brushes aside boys’ right to self-determination.
Considering Germany’s historical background of anti-Semitic excesses that is indeed a big problem! Most advocates of children’s rights would probably have preferred the public debate on circumcision to have been initiated in another country, as this would have saved many fruitless discussions. But after the debate had been triggered following the Cologne verdict on circumcision, children’s rights advocates, given the clear evidence, had no option but to take a stand against circumcision.
It goes without saying that the humanist criticism of circumcision is not directed against Jews. Indeed, it was Jewish men (see i.e. the group “Jews against Circumcision”) who gave the crucial impulses to rethink the practice of circumcising boys. Even if there were isolated political forces that tried to misuse the debate on circumcision for anti-Semitic propaganda, that doesn’t disqualify the objectives of children’s rights advocates, child protection organisations and children’s doctors! Of course they decidedly reject anti-Semitism (as well as anti-Muslimism). But they should be adamant that truths (in this case the knowledge that forced circumcision violates the child’s right of self-determination and its physical integrity) don’t become lies just because liars misuse them. It would be absurd to have to welcome the circumcision of boys despite all counterarguments simply because anti-Semites reject it! That, by the way, would also be the wrong political strategy. Because if one wants to effectively fight inhuman ideologies such as anti-Semitism or anti-Muslimism, one is well advised to curb the respective demagogues’ sphere of activity by deliberately agreeing with the few points in which they are right. Otherwise, they celebrate whole successes using half-truths. This too is a lesson learned from history – and not only Germany’s!
If this argument were solid, it would logically also be valid for the generally accepted ban on female genital cutting. But experience teaches us that government bans have an important signalling effect. Usually they make people rethink their traditional behaviour and adapt it to the new social circumstances. Exactly the practice of boys’ circumcision yields a good example: The official ban on circumcision in the Soviet Union did not lead to an increase of clandestine operations, but rather to a lasting change in the Russian Jews’ behaviour. How sustainable that change in behaviour has proved can be seen from the fact that two decades after their emigration to Germany, the majority continues to spurn circumcision (also demonstrating the absurdity of the claim that Jewish life in Germany would be impossible without circumcision).
An official ban on circumcision where not medically required would have a further advantage: It would help those who already reject circumcision in the interest of their children to justify their decision in the face of the traditionalists in their own family. Above all, such a ban would also be a signal to other countries: If Germany could bring itself to strengthen children’s rights and place a ban on the medically unwarranted circumcision of boys, other countries would soon follow their lead. That in turn could lead to a decrease of the popularity of genital cutting in those regions of the world where the rate of injuries and mortality following circumcision is currently especially high due to poor medical conditions (see question 7).
This accusation turned up surprisingly often in leading German media during the debate on circumcision. It was said that atheists were intruding ever more aggressively into society, acting as if they were the custodians of human rights and thereby misusing “children’s rights” in order to suppress the rights of religious minorities. The journalist Alexander Kissler even hypothesised in the “Jüdische Allgemeine” that the doctor who had informed the police about the circumcised Muslim boy thus precipitating the Cologne verdict on circumcision, belonged to the “neo-atheistic scene”. There’s more: From the cooperation between the Giordano Bruno Foundation, which he labelled as “spearhead of German neo-atheism”, and the professor of criminal law, Holm Putzke, who was the first German lawyer to write a policy article on the criminal relevance of the circumcision of boys, Kissler deduced that the debate on circumcision could have been an intentional, anti-religious conspiracy: “The anti-religious forces are shooting collectively. Anti-Semitism is becoming an excusable collateral damage, not intended, but evidently tolerated.”
What is to be said about these imputations? First of all, we don’t know who informed the police in the case in question. Therefore, speculations about the Weltanschauung of this person are fruitless. But one thing is clear, namely that the Giordano Bruno Foundation does not consider itself the “spearhead of German neo-atheism”, nor as “anti-religious”, but as a “think tank for humanism and enlightenment”. It is true that we advocate a rational worldview, as well as the strengthening of human rights – but that does not necessarily have to collide with religious convictions. It is just as clear that Holm Putzke had published important papers on the issue of circumcision long before coming in contact with the Giordano Bruno Foundation.
So there can be no question of an anti-religious conspiracy! The debate on circumcision was also never about weakening religious freedom but about strengthening it within the framework of other constitutional values (see question 11). Above all, it’s about the strengthening of children’s rights, which have not yet been granted the significance they should have. The Giordano Bruno Foundation has campaigned for children’s rights in the past, for example during the big “protest of institutionalised children” in 2010, where the “black pedagogy” in both state and Christian homes was criticised, or in the course of various campaigns against female genital mutilation. Therefore it was natural that the foundation should enter the debate on circumcision, after having carefully assessed the empirical facts (see questions 1-8).
That our campaign for children’s rights and against circumcision was never remotely a “fundamentalist war on religion” is immediately evident from our explicit inclusion of all kinds of circumcisions performed without medical reasons – not only those of the respective religious rituals. After all, for those affected it doesn’t matter which motives were behind the procedure; in all cases, their rights of self-determination and physical integrity are violated. Whether the reasons are aesthetic, cultural, masturbation inhibiting, “hygienic” or religious – the facts of the matter remain the same.
Author: Dr Michael Schmidt-Salomon, philosopher and spokesman of the Giordano Bruno Foundation in cooperation with the “Working group Children’s Rights” (members on the day the campaign started, August 22 2012: Evelin Frerk, Dr Fiona Lorenz, Katharina Micada, Philipp Möller, Dr Sabine Müller, Frank Nicolai, RA Walter Otte, Prof Dr Holm Putzke, Dr Michael Schmidt-Salomon, Nicolai Sprekels)
Translation: Dr Fiona Lorenz / Editing: Dr Angela Lahee
Remark: The author of this text was circumcised at his own request when he was 17 years old, due to medical indication. Therefore, he knows the problems of circumcision as well as the rationalising strategies of circumcised men not only from letters, but also from his own experience.